Point-of-care coagulation monitoring: Current status of viscoelastic techniques

Abstract

Hemostasis monitoring is becoming increasingly important in the management of bleeding patients in the operating room (OR) and the intensive care unit (ICU) in order to improve outcome and reduce costs of treatment. It has been shown in cardiac surgery that frequent reassessment of the coagulation status and transfusion according to well-structured algorithms reduced blood loss and blood component use when compared with transfusion regimens based on clinician discretion [1, 2]. Routine laboratory based coagulation tests (e.g., prothrombin time [PT]/interna-tional normalized ratio [INR], activated partial thromboplastin time [aPTT], fibrin-ogen) measure clotting times and factors in recalcified plasma after activation with different coagulation activators. Platelet numbers are given to complete overall coagulation assessment. Although the values obtained by routine coagulation testing are accurate, standardized, and have been used for a long time, their use has been questioned in the assessment of a severely bleeding patient because values are measured in plasma, no information on platelet function is available, and there is a time delay of 30-60 min from sampling to obtaining the results. © 2007 Springer Science + Business Media Inc.